title: Effects of nocturnal hemodialysis on melatonin rhythm and sleep-wake behavior: an uncontrolled trial.
abstract: BACKGROUND
  End-stage renal disease and its treatment are associated with sleep disturbances such as deterioration of the circadian sleep-wake pattern. Melatonin rhythm, which has an important role in this pattern, is disturbed. The nocturnal melatonin surge is absent in this population. Whether nocturnal in-center hemodialysis changes melatonin and sleep-wake rhythms is unknown.
  
  
  METHODS
  A nonrandomized uncontrolled trial. Patients served as their own controls.
  
  
  METHODS
  Thirteen daytime hemodialysis patients (median age, 58 years; 5 women) from our hospital receiving conventional daytime hemodialysis 3 times weekly for 3 to 4 hours each session.
  
  
  METHODS
  Six months of treatment with nocturnal in-center dialysis 4 nights/wk with 8-hour sessions.
  
  
  METHODS
  At baseline, while still on conventional hemodialysis therapy, polysomnography was performed, sleep questionnaires were filled out, and melatonin concentration in saliva was obtained. After 6 months of in-center nocturnal hemodialysis, all measurements were repeated.
  
  
  RESULTS
  After 6 months of in-center nocturnal hemodialysis, polysomnography showed significant improvements in sleep efficiency (P = 0.05) and stage 3/4 sleep (P = 0.03) in comparison to t = 0. Trends in improvement of rapid-eye-movement sleep, awake time, and oxygen saturation were seen after 6 months of in-center nocturnal hemodialysis therapy. Sleep questionnaires showed a trend in improved sleep quality and daytime function. Patients were less exhausted during the daytime. The nocturnal melatonin surge was partially restored.
  
  
  CONCLUSIONS
  Small sample size and a nonrandomized uncontrolled study design.
  
  
  CONCLUSIONS
  Patients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm.
authors.affiliation: Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands. bcp.koch@meandermc.nl
authors.forename: Birgit C P
authors.initials: BC
authors.lastname: Koch
authors.forename: E Christiaan
authors.initials: EC
authors.lastname: Hagen
authors.forename: J Elsbeth
authors.initials: JE
authors.lastname: Nagtegaal
authors.forename: Jan B S
authors.initials: JB
authors.lastname: Boringa
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Kerkhof
authors.forename: Piet M
authors.initials: PM
authors.lastname: Ter Wee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008550:Melatonin / Q000378:metabolism*; D008875:Middle Aged; D017286:Polysomnography; D006435:Renal Dialysis / Q000379:methods*; D027544:Salvia / Q000378:metabolism; D012890:Sleep / Q000502:physiology*; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology*
chemical_list: D008550:Melatonin